Given the high rate of cervical cancer in South Africa, can we afford not to vaccinate our daughters?

By Gabisile Ngcobo

20 December 2018

Girls get vaccinated as young as 10 years old. Credit: iStock

The HPV dilemma.

An important development in the fight against cancer – or a licence for kids to go out and have sex? These, in a nutshell, are two sides to one of the most controversial vaccines out there – a jab that has divided opinion pretty much down the middle.

One Cape Town family even believes it has made their daughter seriously ill. But the Department of Health remains adamant: the human papillomavirus (HPV) vaccine has been a great success.

Since the department introduced its immunisation programme in 2014, close to two million preteen girls in public schools have been vaccinated against the disease. HPV is one of the most common causes of cancer of the cervix, a disease contracted by nearly 8 000 women in South Africa each year.

Professor Michael Herbst, health specialist at the Cancer Association of South Africa (Cansa), believes that the rollout is vital.

“We commend the national departments of health and basic education and hope they continue the programme,” he says. Girls in Grade 4 are being vaccinated against HPV at no cost.

Some parents have balked at the idea of their young daughters being vaccinated against a sexually transmitted virus, but between nine and 12 years old is the best time to administer it, says Professor Hennie Botha, head of gynaecological oncology at Stellenbosch University.

“This is when the immune response to the vaccine is strongest,” he explains. Almost all cervical cancers are caused by HPV, a common virus that spreads through skin-to-skin sexual contact, says Herbst.

It’s the most common cancer in females aged 15 to 44 – but experts believe the HPV vaccination programme will result in less diagnoses in this group.

There are two HPV vaccines available in SA: Cervarix, which protects against HPV types 16 and 18; and Gardasil, which protects against HPV types 16, 18, 6 and 11.

Can older women get the jab?

There’s no age limit for the vaccine, Botha says, so older women – and men – can get it if they want to. “However, adolescents and young adults will benefit more than older women,” he adds.

“This is because the vaccine should ideally be given before a person becomes sexually active”, says Professor Yasmin Adam, chief specialist in obstetrics and gynaecology at Chris Hani Baragwanath Academic Hospital and the University of the Witwatersrand.

There is little evidence that the vaccine is effective once a woman has already been exposed to HPV, she says.

“In fact, most of the evidence shows it doesn’t work once the woman has already had an HPV infection. HPV infection is quite prevalent, with up to 50% of women contracting it. In most women the infection clears up, but about 10% will develop lesions on the cervix that are a precursor to cervical cancer.”

Unfortunately, not all women can get the vaccine for free from the state, Botha says. “The vaccine is offered free of charge only to Grade 4 girls at school.”

But it can be obtained from pharmacies from around R400 a dose, with two to three doses being required for it to be most effective, Botha adds.

There are two HPV vaccines available in SA: Cervarix, which protects against HPV types 16 and 18; and Gardasil, which protects against HPV types 16, 18, 6 and 11.

If parents want to get their teenage sons vaccinated they should talk to their family doctor.

What about boys?

Men can also get various cancers as a result of HPV infection but it’s less common compared to women, Botha says.

“Vaccinating boys protects them as well as girls because it stops them passing the virus on. At the moment only girls receive the vaccine for free in South Africa, but some countries, such as Australia, have a gender-neutral programme in which both boys and girls are vaccinated.”

Adam agrees boys will benefit from the vaccine as it reduces HPV-associated conditions such as genital warts as well.

“In those vaccines that prevent HPV strains 6 and 11 there’s a reduction in warts in boys as well as girls who’ve received the vaccination.”

If parents want to get their teenage sons vaccinated they should talk to their family doctor.

“More than 100 million people worldwide have received the HPV vaccine. Its safety has been proven in extensive clinical trials.”

What about side effects?

As with most injected vaccines there may be what are called local side effects, says Professor Gregory Hussey, director of the Vaccines for Africa Initiative (VACFA) at the University of Cape Town.

“These include some redness, swelling and pain at the site of injection, which tend to go away after a few days,” he adds.

Some people may complain of headaches, muscle pain and tiredness, which usually get better after a day or two. Hussey believes the vaccine is safe and doesn’t have significant adverse effects.

“More than 100 million people worldwide have received the HPV vaccine. Its safety has been proven in extensive clinical trials.” But the parents of a young Cape Town girl who has developed serious health problems since getting the HPV vaccine don’t agree.

They say their 10-year-old daughter started getting sick three months after being vaccinated in April 2016, with symptoms of dizziness, weakness, severe body pain that left her unable to walk on her own, and difficulty speaking.

There’s been little improvement in her condition and the girl’s mother said in a Facebook post that her daughter is now “like a little child of about four or five. She has no control over her emotions. She can’t think logically, loses her sense of reality and gets terribly aggressive.”

Professor Pieter Fourie, the paediatrician who’s treating the girl, says it’s “really a difficult case,” and her diagnosis remains unclear. “Everything we’ve tested for has come back negative,” he says, adding that he’s since referred her to a psychiatrist for an assessment.

The “discomforting” thing about her condition, Fourie says, is that all her symptoms started after the vaccination.

“So, from a logical-deduction point of view, there could be a causal relationship between the vaccination and the onset of symptoms. Theoretically, the vaccine should be safe, but we know from the results published by the pharmaceutical companies manufacturing these vaccines that a small percentage of children do exhibit strange reactions – it’s in the package insert,” Fourie says.

According to Mark van der Heever, the Western Cape health department’s deputy director of communications, the matter was investigated and it was found that the girl’s symptoms weren’t due to the vaccine.

“The vaccine contains nothing that can cause cancer or other illnesses,” he says.